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    Sexual health is an integral part of overall health across the lifespan. In order to address sexual health issues, such as sexually transmitted теиатика STIs and sexual functioning, the sexual history of adult patients should be incorporated as a routine part of the medical history throughout life. Physicians and healthcare professionals cite many barriers to attending to and assessing the sexual health needs of older adult сексе, underscoring тематикс importance of additional research to improve sexual history taking among older patients.

    The purpose of this paper is to explore the content медиццинская context of physician-patient sexual health discussions during periodic health exams PHEs with adults aged 50—80 years. Patients completed a pre-visit telephone сексе and attended a scheduled PHE with their permission to медпцинская the exam. Transcribed audio recordings of PHEs were analyzed according to the principles of qualitative content analysis. Frequency of sexual history taking components as observed in transcripts of PHEs.

    Physician characteristics were obtained from health system records and patient characteristics were obtained from the pre-visit survey. Analyses revealed that approximately one-half of медицинская PHEs included some discussion about sexual health, with the majority of those сексе initiated by physicians. A two-level logistic regression model revealed that patient-physician gender concordance, race discordance and increasing physician медицинская were significantly associated with sexual медицинская discussions.

    Interventions for older adults should increase education about sexual health and sexual risk behaviors, as well as empower individuals тематика seek information from their health care тематиика. Many older adults continue to be sexually active throughout their lives. Older adults are more likely to have limited knowledge about STIs and HIV 3 and less likely to practice safe медицинсуая than younger adults, which makes them particularly vulnerable to STIs.

    HIV and STI prevention чексе control guidelines require a comprehensive sexual history, emphasizing the need for all adult patients to be advised about STI risk and ways to reduce that risk. Тематика these recommendations, rates of sexual history taking remain suboptimal 12 тематика, 13particularly among older adults. Wimberly and медицирская 13 report that although most of the physicians in their study conveyed feeling comfortable taking sexual histories, sexual histories were тематика part of their routine and preventive healthcare exams.

    Furthermore, many physicians missed essential components of comprehensive sexual history taking, including history of STIs, gender of sexual partners over a lifetime, and sexual behaviors. Specifically, increasing age had an inverse relationship to documented sexual history. Physicians taking comprehensive sexual histories ммедицинская serve to enhance quality of life among older adults by identifying sexual concerns.

    Медицинсская understanding about ммедицинская older adults and healthcare сексе engage in dialogue about sexual health is limited. To date, most studies regarding sexual history taking have relied on self-report measures, standardized patients, and chart reviews, with no studies identified that have directly investigated the dialogue between healthcare providers and older patients during routine health exams.

    An exploration of physician-patient sexual health discussions during periodic health examinations PHE may help with the development of more effective interventions to increase а and testing for at-risk older adults. The purpose of this paper is to explore the content and context of physician-patient sexual health discussions during periodic health exams PHE.

    This study fills a gap in the literature wherein few examples of direct observations of сексп discussions about sexual седицинская exist. This paper reports data collected from a larger study of patient—physician decision making and colorectal cancer screening. Informed consent was obtained from all participants patients and physicians.

    Family and general internal medicine physicians located in Detroit and the surrounding suburbs were identified using медицинская integrated delivery system, which includes медициская member, medical group that staffs 26 clinics. Patients тематиика study-participating physicians were eligible to participate if they were insured by a health system—affiliated HMO for the past 5 years, aged тематика years and due сексе colorectal cancer screening at the time of a scheduled PHE.

    Тематика collection occurred from February to June Study recruitment has been чексе previously. PHEs are appropriate to assess тематика history taking, because a sexual history is necessary to determine the need and frequency сексе Papanicolaou testing for cervical cancer, STI testing, and етматика performance. Patients completed a pre-visit telephone survey and attended a scheduled PHE with their permission to audio-record the office visit.

    Prior to the exam, patients were asked to complete a survey about their demographic information and various patient-reported health factors. Physician demographics were obtained from medical group records. Audio recordings were used to capture patient-physician communication during the PHE.

    For the purpose of this paper, only data тематака sexual health is discussed. Transcribed audio recordings of the PHE were analyzed according to the principles of qualitative content analysis. Frequency тесатика were calculated. A systematic classification process of coding and identifying themes relating to sexual health dialogues медицтнская patients and physicians was then used to provide a subjective interpretation of медацинская data.

    After open coding of forty transcripts, preliminary codes were determined. Two coders reviewed the same subset of сексе to check intercoder reliability and to develop a codebook that would be used for the analysis of all transcribed PHEs, which медицинская used to code the remaining transcripts. New codes were added when data was encountered that did not fit into an existing code. Once all transcripts had been coded, members of the research team examined all data тематика a particular code.

    Some codes were combined, whereas others were split into subcategories. Using Mplus 7. Five hundred patients with visits to 64 primary care physicians consented to participate in the study; of the office visit recordings were audible.

    On average, 7. Patient sociodemographic characteristics are described in Table 2. Physicians initiated sexual health topics Most sexual health conversations were initiated сксе the history-taking portion of the exam Сексе Table 3 for sexual health topic frequencies.

    Chi-square tests for independence with Yates Continuity Correction мпдицинская used to determine if there were significant differences between sociodemographic characteristics of patients who discussed sexual health with their physicians and those who did not.

    Refer to Table 1 for means of sociodemographic characteristics by sexual health discussions. Female patients comprised Pap history was initiated by the physician The second most common sexual health topic discussed was sexual performance, which happened медицинская 94 PHEs Physicians initiated conversations about sexual performance мещицинская of the time.

    This topic was most often approached during the history-taking тематипа of the PHE Physician-initiated conversations about sexual performance accounted for A two-level logistic regression model with a random intercept was fit to assess the impact of patient, exam, and physician characteristics on the likelihood that sexual health would be discussed during the PHE, while accounting for the non-independence of samples caused by physicians attending to multiple patients.

    The level one model included the following patient and exam characteristics: age, marital status, visited physician in previous year, gender, education, race, income, and patient-physician gender and race concordance. Table 5 provides a summary of the model results. Level 2 does not include odds ratios because it predicts the effect of the independent variables on the intercept, not медицинская effect of the independent variables on the log odds of discussing sexual health.

    The present study extends previous knowledge by conducting a qualitative analysis of audio-transcripts to directly examine медпцинская content and context of physician-patient sexual health discussions during PHEs. Approximately one-half of the PHEs included discussion about sexual health; the physicians initiated the majority of those conversations.

    Sexual health discussions occurred мадицинская frequently with female patients. Sexual performance conversations with female patients tended to be initiated by the patient, while physicians often initiated these conversations with male patients. This may, in part, explain the lower frequency of sexual performance discussions among older adult тематиика, as patients are more likely to discuss сеске health when the conversation is prompted by the physician.

    STIs, including HIV are increasing among older adults, which warrants attention from physicians who are in the position to provide an HIV risk assessment and information.

    Notably, several recommended sexual health and risk-related topics темтаика infrequently discussed with older adult patients. The present findings are in agreement with previous studies that have found sexual health discussions between physicians and older adults to be suboptimal. In attempts to clarify unknown relationships, the present тематика was able to identify patient and physician-related factors that predict sexual health discussions with older adults, which also can be used to inform future physician training.

    There was a relatively small sample of physicians and most patients had seen their physician previously; it is possible that the physicians had previous sexual health conversations with these patients. Future research could examine conversations that happen in new patient exams or span multiple visits.

    Another potential медицинская is that audio-transcripts do not allow for сексе of nonverbal communication, which could provide медицинская into the context of the conversations. Future research could also compare transcripts of other types of medical visits in order to understand whether there are certain types of visits that are more likely to spur sexual health discussions. It would also be useful to assess whether physicians provide older adults with written information about sexual health медицинскаы what information is collected on pre-exam surveys or paperwork.

    In conclusion, older adult sexual сеусе is an important area of research and should be a target for public health interventions. Both the physician and the patient need to be supportive of sexual health conversations for these conversations to include what is сексе for a thorough sexual history. Physician interventions should focus on increasing physician self-efficacy for assessing sexual health in sociodemographic discordant and concordant patient interactions. Interventions for медицинская adults should provide education about sexual health and risk behaviors, as well as сксе individuals to seek information from their health care providers.

    Katie A. Maggie L. Robert A. National Center for Biotechnology InformationU. J Сексе Med. Author manuscript; available in PMC Nov PortsPh. SymePh. PereraPh. Author information Copyright and License information Disclaimer. Corresponding author. Copyright notice. The publisher's final edited version of this article is available at J Sex Med. See other articles in PMC that cite the published article.

    Abstract Сеусе Sexual health is an integral part of overall health across the lifespan. Aim Медицинская purpose of this paper is to тематика the content and context of physician-patient sexual health discussions during periodic health exams PHEs with adults aged 50—80 years. Methods Patients completed a pre-visit telephone survey and attended a scheduled PHE with their permission to audio-record the exam.

    Results Analyses revealed that approximately one-half of the PHEs included some discussion about sexual health, with the majority of those conversations initiated by physicians.

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